<div class="layuimini-container">
    <form id="app-form" class="layui-form layuimini-form" method="post">
        
        <div class="layui-form-item">
            <label class="layui-form-label">账号</label>
            <div class="layui-input-block" disabled="disabled">
                <input type="text" name="name" class="layui-input" disabled placeholder="请输入账号" value="{$row.name|default=''}">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">联系方式</label>
            <div class="layui-input-block" disabled="disabled">
                <input type="text" name="phone" class="layui-input" disabled placeholder="请输入联系方式" value="{$row.phone|default=''}">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">驳回原因</label>
            <div class="layui-input-block">
                <input type="text" name="examine_content" class="layui-input"  placeholder="请输入审核驳回原因" value="">
            </div>
        </div>
        <div class="hr-line"></div>
        <div class="layui-form-item text-center">
            <button type="submit" class="layui-btn layui-btn-normal layui-btn-sm" lay-submit>确认</button>
            <button type="reset" class="layui-btn layui-btn-primary layui-btn-sm">重置</button>
        </div>

    </form>
</div>